Risk Factors for Post-Operative Infections after Cesarean Section
Methods: Retrospective chart review of patients who underwent a cesarean section between 1/1/2013 – 6/31/2013 was conducted at an academic institution. Post-operative infection was defined as any infection within 30 days from date of primary surgery using the CDC criteria as guideline. Chi square was used for comparison of all categorical data and we reported spearman correlation coefficient. The Student T test was used for continuous variables and p values reported. Univariate analysis was done with significance determined at P<0.05. Variables with P < 0.05 were then subsequently run through a multivariate analysis. A total of 1,189 charts were included in our final analysis.
Results: We had 56% (n=672) primary and 44% (n=526) repeat cesarean sections. 47% were scheduled (n=564), 48% unscheduled (n=571) and 5% emergent (n=62).
Post-operative infection after cesarean section was 7.6% (n=91). On univariate analysis, risk factors associated with post-operative infections include primary cesarean section (OR,1.66 [95% CI,1.05-2.63]), Non-Elective cesarean section (OR, 1.92 [1.03-3.57]); sexually transmitted infection in pregnancy (OR, 3.83 [1.50-9.79]), cervical shortening <15cm (OR, 3.72 [1.34-10.33]), PPROM (OR, 5.3 [1.82-15.38]) gestational HTN (OR, 2.38 [1.08-5.23]), asthma (OR, 3.83 [1.50-9.79]), intraoperative estimated blood loss >1000mL (OR, 2.27 [1.08-4.77]), Chorioamnionitis, (OR, 2.8 [1.5-5.1], p=.0004), and blood transfusion during the hospital stay (OR, 3.5 [95% CI, 1.5-8.2]). On subgroup analysis, skin closure with staples was associated with increasing rates of wound infection (OR, 1.88 [1.08-3.33]). Continuous or Multi-categorical values associated with post-operative infection were decreasing post-operative hemoglobin (p=0.0229), length of membrane rupture (<0.0001), increasing BMI (p=0.0042), Classical Incision (p<0.0003), any intraoperative complication (p=.0048), and Emergent Surgery (p<0.001).
Conclusion: Study identifies modifiable risk factors for post-operative infection after cesarean section. Identification of these risk factors allows targeted measures to be instituted, resulting in reduced infection rate.
M. Lachiewicz, None
M. Buechel, None